RESUMO
The clinical benefit of machine perfusion (MP) was recently assessed in a 1-year Brazilian multicenter prospective randomized trial, that showed that the use of MP was associated with a reduced incidence of delayed graft function (DGF) compared to static cold storage (SCS) in kidney transplant recipients (45% vs 61%). The objective of the present analysis is to consider the cost-effectiveness of MP relative to SCS based on clinical data from this Brazilian cohort. A decision tree model was constructed to simulate a population of 1000 kidney transplant recipients based on data derived from this Brazilian multicenter clinical trial. The model accounts for different health state utilities to estimate the cost-effectiveness of deceased donor kidney transplantation in Brazil comparing 2 kidney preservation methods: MP and SCS. The model accounts for 3 possible graft outcomes at 1 year post-transplantation: success (an immediate functioning kidney), failure (primary nonfunction requiring a return to dialysis), or DGF 1 year post-transplant. MP provided 612 total quality-adjusted life years (QALYs) (0.61 QALYs per patient) as compared to SCS (553 total QALYs, 0.55 QALYs per patient). MP was cost effective relative to SCS (US$22,117/QALY, R$70,606/QALY). The use of MP also resulted in more functioning grafts than SCS (821 vs 787), leading to a cost per functioning graft of US$38,033 (R$121,417). In conclusion, this analysis indicates that, despite the initial added cost associated with MP, the use of MP results in more functioning grafts (821 vs 787) and higher patient quality of life relative to SCS in Brazil.
Assuntos
Função Retardada do Enxerto/prevenção & controle , Transplante de Rim/economia , Preservação de Órgãos/economia , Adulto , Brasil , Análise Custo-Benefício , Criopreservação/economia , Criopreservação/métodos , Árvores de Decisões , Função Retardada do Enxerto/economia , Função Retardada do Enxerto/fisiopatologia , Sobrevivência de Enxerto , Humanos , Incidência , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Preservação de Órgãos/métodos , Perfusão/economia , Perfusão/métodos , Estudos Prospectivos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
UNLABELLED: We examined the association of serum 25-hydroxyvitamin D [25(OH)D] with indices of bone quality in older men. Positive associations for 25(OH)D and bone mineral density, content, cortical thickness, and axial and polar strength strain indices were observed among Caucasians; however, among men of African descent findings were either null or negative. INTRODUCTION: There are limited data on serum 25(OH)D and bone measures in men of African ancestry. To better understand racial differences in vitamin D status and bone health, a cross-sectional study among 446 Caucasian men in the US and 496 men of African ancestry in Tobago (age ≥ 65 years) was conducted. METHODS: Serum 25(OH)D (liquid chromatography and tandem mass spectrometry) was measured, and peripheral quantitative computed tomography scans were administered. Bone measures estimated included trabecular and cortical volumetric bone mineral density (vBMD), bone mineral content (BMC), bone geometry (cross-sectional area and cortical thickness), and polar and axial strength strain indices (SSIp and SSIx). RESULTS: Men of African ancestry had higher 25(OH)D than Caucasians (34.7 vs. 27.6 ng/ml, p < 0.01). Among Caucasians, 25(OH)D was positively (p trend < 0.05) associated with cortical vBMD, total BMC, cortical thickness, SSIp, and SSIx at the distal radius after adjustment for potential confounders. Similar patterns were observed at the distal tibia. In contrast, in men of African ancestry, there was an inverse association (p trend < 0.05) between 25(OH)D and the cross-sectional area, and SSIx. Race modified (p for interaction < 0.05) the association between 25(OH)D and total BMC, cross-sectional area, SSIp, SSIx, and trabecular vBMD of the radius. In men of African ancestry, there was evidence of a threshold effect (at approximately 18 ng/ml) for 25(OH)D on tibial total BMC and cortical thickness. CONCLUSIONS: More studies are needed to better comprehend these race differences for 25(OH)D and bone density, geometry, and indices of bone strength.
Assuntos
Densidade Óssea/fisiologia , Rádio (Anatomia) , Tíbia , Vitamina D/análogos & derivados , Idoso , População Negra , Estudos Transversais , Humanos , Masculino , Pennsylvania , Rádio (Anatomia)/anatomia & histologia , Rádio (Anatomia)/fisiologia , Tíbia/anatomia & histologia , Tíbia/fisiologia , Trinidad e Tobago/etnologia , Vitamina D/sangue , População BrancaRESUMO
African ancestry individuals have a more favorable lipoprotein profile than Caucasians, although the mechanisms for these differences remain unclear. We measured fasting serum lipoproteins and genotyped 768 tagging or potentially functional single nucleotide polymorphisms (SNPs) across 33 candidate gene regions in 401 Afro-Caribbeans older than 18 years belonging to 7 multi-generational pedigrees (mean family size 51, range 21-113, 3,426 relative pairs). All lipoproteins were significantly heritable (P<0.05). Gender-specific analysis showed that heritability for triglycerides was much higher (P<0.01) in women than in men (women, 0.62+/-0.18, P<0.01; men, 0.13+/-0.17, P>0.10), but the heritability for LDL cholesterol (LDL-C) was higher (P<0.05) in men than in women (men, 0.79+/-0.21, P<0.01; women, 0.39+/-0.12, P<0.01). The top 14 SNPs that passed the false discovery rate threshold in the families were then tested for replication in an independent population-based sample of 1,750 Afro-Caribbean men aged 40+ years. Our results revealed significant associations for three SNPs in two genes (rs5929 and rs6511720 in LDLR and rs7517090 in PCSK9) and LDL-C in both the family study and in the replication study. Our findings suggest that LDLR and PCSK9 variants may contribute to a variation in LDL-C among African ancestry individuals. Future sequencing and functional studies of these loci may advance our understanding of genetic factors contributing to LDL-C in African ancestry populations.
Assuntos
População Negra/genética , Estudos de Associação Genética , Lipoproteínas/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , LDL-Colesterol/sangue , LDL-Colesterol/genética , Feminino , Frequência do Gene , Genótipo , Humanos , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Linhagem , Trinidad e Tobago , Adulto JovemRESUMO
Previous investigations have documented a reduced activity of the sodium-potassium-stimulated adenosine triphosphatase enzyme (Na+,K+ ATPase) in platelet membranes of allergic subjects. The purpose of this study was to determine if the reduced Na+,K+ ATPase activity was due to an enzyme inhibitor. Na+,K+ ATPase activity of a particulate fraction of sonicated platelets was determined by spectrophotometry in asymptomatic adults with and without allergy. The Na+,K+ ATPase level (mean, nanomoles per microgram of protein per minute; +/- STD) of allergic subjects (0.9 +/- 1.3) was lower (p less than 0.001) than that of nonallergic subjects (3.9 +/- 1.6). In contrast, when the same platelet fractions were frozen before assay, Na+,K+ ATPase was higher (p less than 0.005) in allergic subjects (6.0 +/- 1.4) than in nonallergic subjects (3.6 +/- 2.0). An inhibitor of canine kidney Na+,K+ ATPase was detected in the buffer in which these platelet fractions were frozen, allergic subjects (0.5% +/- 0.4% inhibition per microgram of protein) compared to nonallergic subjects (0.04% +/- 0.08%; p less than 0.005). The level of inhibition correlated positively with the postfreezing increase in platelet membrane Na+,K+ ATPase, suggesting a freezing-induced displacement of an inhibitor from the membrane. Plasma from these same subjects inhibited Na+,K+ ATPase activity of normal platelets, allergic subjects (70% +/- 31% inhibition) compared to nonallergic subjects (13% +/- 16%; p less than 0.001). These data suggest that the transport-enzyme defect observed in platelets from allergic subjects was due to a circulating Na+,K+ ATPase inhibitor. In vivo Na+,K+ ATPase inhibition in allergy could have profound effects on intracellular cation concentrations and broad implications for pathogenesis.
Assuntos
Asma/sangue , Plaquetas/enzimologia , Rinite Alérgica Perene/sangue , Rinite Alérgica Sazonal/sangue , ATPase Trocadora de Sódio-Potássio/antagonistas & inibidores , Adulto , Asma/etiologia , Membrana Celular/enzimologia , Congelamento , Humanos , Rinite Alérgica Perene/etiologia , Rinite Alérgica Sazonal/etiologia , ATPase Trocadora de Sódio-Potássio/sangueRESUMO
It has been postulated that the hepatocarcinogenicity of a choline-devoid diet in rats stems from peroxidation of liver lipids. We have investigated whether the diet contains conjugated dienes that could account directly for those detected in liver lipids of rats fed a choline-devoid diet. Analyses were performed on samples of corn oil and of a partially hydrogenated fat used to prepare semipurified choline-devoid and choline-supplemented diets, and on fat extracted from two pairs of diets, one set containing 5% corn oil and 10% partially hydrogenated fat, and the other only corn oil (15%). The analyses consisted of quantitation of conjugated dienes by UV spectrophotometry, separation of fatty acids with conjugated dienes by HPLC, and quantitation of trans fatty acids by IR spectrophotometry. Small levels of conjugated diene and trans fatty acids were present in the corn oil, but much higher amounts were found in the partially hydrogenated fat. HPLC analysis yielded distinct elution profiles for the fatty acids with conjugated dienes present in the two fats, and similar results were obtained with fat extracted from the diets. However, no differences were observed between choline-devoid and control choline-supplemented diets. The results indicate that caution must be exercised in interpreting data from UV analysis of tissue lipids of rats fed diets containing a partially hydrogenated fat.